Prenatal factors associated with fetal visceral adiposity<sup>,</sup>

Sena, Aline Silva Santos; Souza, Alex Sandro Rolland de; Barros, Vivianne de Oliveira; Lima, Maria do Carmo Pinto; Melo, Adriana Suely Oliveira; Amorim, Melania Maria Ramos de

doi:10.1016/j.jped.2018.11.013

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Original articles • J. Pediatr. (Rio J.) 96 (3) • May-Jun 2020 • https://doi.org/10.1016/j.jped.2018.11.013 copy

Prenatal factors associated with fetal visceral adiposity^☆ ☆ Please cite this article as: Sena AS, Souza AS, Barros VO, Lima MC, Melo AS, Amorim MM. Prenatal factors associated with fetal visceral adiposity. J Pediatr (Rio J). 2020;96:341-9. ^,^☆☆ ☆☆ Study conducted at Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, PE, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To assess fetal visceral adiposity and associated factors during pregnancy.

Methods:

Secondary analysis of prospective cohort data with 172 pairs (pregnant woman/fetus) treated at public health units. Anthropometric data, metabolic (glucose, glycated hemoglobin, insulin, insulin resistance, total cholesterol and fractions, triglycerides) measures, fetal biometry, and visceral and subcutaneous adiposity in the binomial (pregnant woman/fetus) were evaluated at the 16^th, 28^th and 36^th gestational weeks by ultrasonography. Pearson's correlation coefficient and multiple linear regression were used, with a significance level of 5%.

Results:

At the 16^th week, the mean age of the pregnant women was 26.6 ± 5.8 years and mean weight was 62.7 ± 11.5 kg; 47.0% had normal weight, 28.3% were overweight, 13.3% were underweight, and 11.2% were obese. At 36 weeks, 44.1% had inadequate gestational weight gain, 32.5% had adequate gestational weight gain, and 23.3% had excessive gestational weight gain. Fetal visceral adiposity at week 36 showed a positive correlation with maternal variables: weight (r = 0.15) and body mass index (r = 0.21) at the 16^th; with weight (r = 0.19), body mass index (r = 0.24), and gestational weight gain (r = 0.21) at the 28^th; and with weight (r = 0.22), body mass index (r = 0.26), and gestational weight gain (r = 0.21) at the 36^th week. After multiple linear regression, adiposity at the 28^th week remained associated with fetal variables: abdominal circumference (p < 0.0001), head circumference (p = 0.01), area (p < 0.0001), and thigh circumference (p < 0.001). At the 36^th week, adiposity remained associated with the abdominal circumference of the 28^th (p = 0.02) and 36^th weeks (p < 0.001).

Conclusion:

Adiposity was positively correlated with the measurements of the pregnant woman. After the multivariate analysis, the persistence of the association occurred with the abdominal circumference, a central adiposity measurement with a higher metabolic risk.

KEYWORDS
Adiposity; Weight gain; Pregnancy; Subcutaneous fat; Ultrasonography

Maternal variables	X̅±SD
Age, years	26.6 ± 5.8
Schooling, years (Md, IQR^\|)	3.0 (0.8-15)
Interpregnancy interval	3.5 ± 3.2
Number of pregnancies (Md, IQR^\|)	2 (0-10)
Parity (Md, IQR)	1 (0-1.5)
Suprailiac fold	23.0 ± 9.2
Tricipital fold	21.5 ± 6.0
Visceral adiposity, centimeters	5.2 ± 1.3
Subcutaneous adiposity, centimeters	2.3 ± 0.8
BMI (kg/m²)	25.0 ± 4.3

Classification according to BMI	n (%)
Low weight	24 (13.0)
Normal weight	92 (48.7)
Overweight/Obesity	71 (38.7)
Total	187 (100.0)
Weight gain, kg	1.1 ± 2.9

Classification of weight gain (36th week)	n (%)
Inadequate	72 (44.1)
Adequate	53 (32.5)
Excessive	38 (23.3)
Total	163 (100.0)
Gestational diabetes	5 (2.8%)
Alcohol consumption	19 (9.5%)
Smokers	11 (6%)
Users of illicit drugs	01 (0.5%)

Laboratory tests	X̅±SD
Total cholesterol, mg/dL	169.6 ± 30.8
HDL cholesterol, mg/dL	50.3 ± 11.1
LDL cholesterol, mg/dL	97.2 ± 24.0
Triglycerides, mg/dL	112.4 ± 56.7
Fasting glycemia, mg/dL	70.1 ± 15.2
Fasting insulin	5.8 ± 4.1
HOMA-IR	18.5 ± 14.2

Fetal variables	X̅±SD
Fetal visceral adiposity, millimeters (28th week)	4.4 ± 0.5
Fetal visceral adiposity, millimeters (36th week)	6.1 ± 0.6
Fetal subcutaneous adiposity, millimeters (36th week)	4.4 ± 1.6

Maternal variables	Fetal visceral adiposity (28th week)			Fetal visceral adiposity (36th week)
	r	95% CI	p	r	95% CI	p
Age	-0.04	-0.19 to 0.10	0.53	-0.06	-0.21 to 0.09	0.42
Schooling	0.04	-0.10 to 0.19	0.58	0.05	-0.10 to 0.20	0.52
Per capita income	0.09	-0.05 to 0.24	0.19	-0.01	-0.16 to 0.14	0.89
Smoking	-0.05	-0.20 to 0.09	0.49	-0.00	-0.16 to 0.15	0.93
No. of pregnancies	-0.16	-0.31 to -0.00	0.03	-0.06	-0.22 to 0.09	0.40
Interpregnancy interval	-0.02	-0.20 to 0.16	0.81	-0.21	-0.38 to 0.02	0.03
No. of prenatal visits	-0.03	-0.18 to 0.12	0.69	0.05	-0.10 to 0.21	0.48
Parity	-0.11	-0.26 to 0.04	0.14	-0.03	-0.20 to 0.12	0.63
Height	0.03	-0.11 to 0.18	0.66	-0.07	-0.22 to 0.08	0.36
Pre-gestational weight	0.02	-0.12 to 0.17	0.73	0.14	-0.01 to 0.29	0.07
Pre-gestational BMI	0.01	-0.13 to 0.16	0.86	0.15	-0.00 to 0.30	0.05

16th week
Visceral adiposity	0.00	-0.14 to 0.15	0.96	0.02	-0.14 to 0.17	0.83
Weight	0.00	-0.14 to 0.15	0.92	0.15	0.00 to 0.30	0.04
BMI	0.02	-0.12 to 0.17	0.75	0.21	0.05 to 0.35	<0.0001
Weight gain	-0.00	-0.15 to 0.14	0.92	0.08	-0.07 to 0.23	0.29
Total cholesterol	0.03	-0.12 to 0.19	0.66	0.07	-0.09 to 0.24	0.38
LDL-c	0.09	-0.07 to 0.24	0.27	0.06	-0.10 to 0.23	0.45
HDL-c	0.07	-0.08 to 0.23	0.34	0.15	-0.01 to 0.31	0.08
Triglycerides	-0.19	-0.33 to -0.02	0.02	0.10	-0.07 to 0.27	0.25
Glycemia	-0.05	-0.20 to 0.11	0.55	0.05	-0.11 to 0.22	0.49
Insulin	-0.10	-0.26 to 0.06	0.23	0.07	-0.10 to 0.24	0.41
HOMA-IR	-0.09	-0.25 to 0.07	0.26	0.08	-0.09 to 0.25	0.34
HgbA1-c	0.01	-0.17 to 0.20	0.84	0.04	-0.15 to 0.25	0.64

28th week
Weight	0.03	-0.12 to 0.17	0.69	0.19	0.03 to 0.34	0.01
BMI	0.02	-0.12 to 0.17	0.70	0.24	0.08 to 0.38	<0.0001
Weight gain	0.11	-0.03 to 0.26	0.14	0.21	0.05 to 0.36	<0.0001
Glycemia	-0.07	-0.25 to 0.11	0.46	-0.08	-0.26 to 0.10	0.40

36th week
Weight	0.11	-0.04 to 0.26	0.16	0.22	0.07 to 0.37	<0.0001
BMI	0.11	-0.05 to 0.26	0.17	0.26	0.10 to 0.40	<0.0001
Weight gain	0.11	-0.04 to 0.27	0.15	0.21	0.05 to 0.36	<0.0001
Total cholesterol	-0.01	-0.17 to 0.15	0.87	-0.12	-0.28 to 0.03	0.12
LDL-c	-0.06	-0.22 to 0.10	0.47	-0.19	-0.35 to 0.02	0.02
HDL-c	0.15	-0.02 to 0.30	0.08	0.13	-0.02 to 0.29	0.09
Triglycerides	-0.07	-0.23 to 0.09	0.38	-0.01	-0.17 to 0.15	0.86
Glycemia	-0.08	-0.23 to 0.09	0.37	0.09	-0.07 to 0.25	0.26
Insulin	-0.15	-0.31 to 0.02	0.10	0.12	-0.05 to 0.29	0.17
HOMA-IR	-0.05	-0.19 to 0.10	0.54	0.03	-0.12 to 0.18	0.69
HgbA1-c	-0.00	-0.17 to 0.16	0.95	0.14	-0.02 to 0.30	0.09

Fetal variables	Fetal visceral adiposity (28th week)			Fetal visceral adiposity (36th week)
	r	95% CI	p	r	95% CI	p
Gender	0.04	-0.11 to 0.18	0.62	-0.03	-0.18 to 0.12	0.72

28th week
Estimated fetal weight	0.22	0.07 to 0.36	<0.0001	0.21	0.04 to 0.35	0.01
Visceral adiposity	-	-	-	0.14	-0.02 to 0.29	0.09
Head circumference	0.28	0.13 to 0.41	<0.0001	0.09	-0.06 to 0.24	0.25
Abdominal circumference	0.01	-0.14 to 0.15	0.94	0.20	0.04 to 0.34	0.01
Thigh area	0.39	0.25 to 0.50	<0.0001	0.26	0.11 to 0.40	<0.0001
Thigh circumference	0.13	-0.02 to 0.27	0.10	0.23	0.07 to 0.37	<0.0001
Thigh thickness	-0.05	-0.20 to 0.09	0.48	0.14	-0.01 to 0.29	0.08
Femur length	-0.01	-0.16 to 0.13	0.85	0.17	0.01 to 0.32	0.03

36th week
Estimated fetal weight	0.19	0.02 to 0.33	0.02	0.46	0.32 to 0.57	<0.0001
Visceral adiposity	0.14	-0.02 to 0.29	0.09	-	-	-
Subcutaneous adiposity	-0.14	-0.29 to 0.02	0.11	0.09	-0.07 to 0.25	0.27
Head circumference	0.21	0.04 to 0.35	0.01	0.15	-0.00 to 0.30	0.06
Abdominal circumference	0.18	0.02 to 0.33	0.03	0.50	0.37 to 0.60	<0.0001
Thigh area	0.10	-0.06 to 0.25	0.24	0.35	0.20 to 0.48	<0.0001
Thigh circumference	0.12	-0.04 to 0.27	0.15	0.35	0.19 to 0.47	<0.0001
Thigh thickness	0.12	-0.04 to 0.27	0.16	0.05	-0.10 to 0.20	0.50
Femur length	0.06	-0.10 to 0.22	0.47	0.25	0.09 to 0.39	<0.0001

Visceral adiposity (28th week)
Fetal variables	Coefficient	Standard error	p ^a a Stepwise multiple linear regression. (Equation = visceral adiposity at 28 weeks = -3.84 + thigh area at 28th week -0.14 + 0.03). (Equation = visceral adiposity at 28 weeks = -3.84 + abdominal circumference at the 28th week 0.16 + 0.03). (Equation = visceral adiposity at 28 weeks = -3.84 + thigh circumference at the 36th week 0.12 + 0.05). (Equation = visceral adiposity at 28 weeks = -3.84 + head circumference at the 36th week 0.15 + 0.05). (Equation = visceral adiposity at 36 weeks = -3.54 + abdominal circumference at the 28th week 0.11 + abdominal circumference at 36th week 0.18 + 0.05).
Thigh area (28th week)	-0.14	0.03	<0.0001
Abdominal circumference (28th week)	0.16	0.03	<0.0001
FTC (28th week)	0.15	0.05	<0.0001
Head circumference (36th week)	0.12	0.05	0.01
CONSTANT	-3.84

Visceral adiposity (36th week)
Fetal variables	Coefficient	Standard error	p ^a a Stepwise multiple linear regression. (Equation = visceral adiposity at 28 weeks = -3.84 + thigh area at 28th week -0.14 + 0.03). (Equation = visceral adiposity at 28 weeks = -3.84 + abdominal circumference at the 28th week 0.16 + 0.03). (Equation = visceral adiposity at 28 weeks = -3.84 + thigh circumference at the 36th week 0.12 + 0.05). (Equation = visceral adiposity at 28 weeks = -3.84 + head circumference at the 36th week 0.15 + 0.05). (Equation = visceral adiposity at 36 weeks = -3.54 + abdominal circumference at the 28th week 0.11 + abdominal circumference at 36th week 0.18 + 0.05).
Abdominal circumference (28th week)	0.11	0.05	0.02
Abdominal circumference (36th week)	0.18	0.05	<0.0001
CONSTANT	-3.54

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[1] * Corresponding author. E-mail:ft.alinesena@hotmail.com (A.S. Sena).